Evidence for response set effects in structured research interviews.

The Addiction Severity Index and NIMH Diagnostic Interview Schedule data of 20 methadone-maintained subjects with "fake bad" invalid profiles on the Personality Assessment Inventory, 15 methadone-maintained subjects with "fake good" invalid profiles, and 158 methadone-maintained subjects with valid profiles were compared. The findings revealed a number of significant group differences on both measures with the highest scores for the fake bad subjects and lowest scores for the fake good subjects. These findings suggest that the response sets exhibited in response to the Personality Assessment Inventory questionnaire extended to performance during the two semi-structured interviews. There was no indication that interviewers were aware of misrepresentation. The limitations of the findings and alternative interpretations of the data are considered.

Personality disorders and treatment outcome in methadone maintenance patients.

This study examined the relationship between personality disorder (PDs) and 7-month treatment outcome in 197 men admitted to methadone maintenance. Subjects reported pervasive improvement, and the amount of improvement did not significantly differ for those subjects with and without PDs. PD subjects entered treatment with more severe self-reported drug, alcohol, psychiatric, and legal problems, and despite progress, remained more problematic in those areas relative to subjects without PDs. Subjects with antisocial PD had admission and 7-month problem status similar to subjects with other PDs. The 7-month urinalysis results for opiates and cocaine showed no significant differences between subjects with and without PDs. Fewer PD subjects stayed in treatment continuously for the 7-month period. Several cluster B PDs-borderline, antisocial, and histrionic-predicted poorest overall outcomes. Methadone-maintained patients with PDs may warrant additional treatment services if they are to approach the functional level of patients without PDs.

Gender differences in diagnosing antisocial personality disorder in methadone patients.

OBJECTIVE: The goal of this study was to evaluate gender differences in the prevalence rates, short-term reliability, and internal consistency of the diagnosis of antisocial personality disorder for DSM-III-R, DSM-III, and Research Diagnostic Criteria (RDC). METHOD: A total of 37 men and 57 women methadone patients were diagnosed according to DSM-III-R, DSM-III, and RDC antisocial personality disorder criteria. RESULTS: The diagnostic rates, reliability, and internal consistency were lower for women than for men in all systems. DSM-III criteria resulted in the highest reliability for women, but for men, the DSM-III criteria were the least reliable. Examination of endorsement rates of individual antisocial personality disorder criteria revealed several significant gender differences on the majority of childhood criteria and on several adult criteria. Item-total correlations revealed that for women, the violent and aggressive childhood criteria in DSM-III-R that had not been included in DSM-III or RDC had a negative or no correlation to the assessment of antisocial personality disorder for women. CONCLUSIONS: The change in DSM-III-R from DSM-III childhood criteria appears to have resulted in a decrease in internal consistency and rates of antisocial personality disorder for women, but not for men. The results of this investigation indicate that the psychometric properties of the current antisocial personality disorder scales are weak for women, compared with men. To assess antisocial personality disorder in women it may be necessary to revise current, or develop new, diagnostic criteria.

Treatment response of antisocial substance abusers.

We evaluated the relationship of antisociality to 7-month treatment response in 224 alcohol-and/or cocaine-dependent men. Subjects with and without a DSM-III antisocial personality disorder (ASPD) responded similarly and positively to treatment in a number of functional domains, including substance use. A more detailed analysis comparing subjects with ASPD, subjects meeting adult but not childhood ASPD criteria (A-ASPD), and subjects meeting neither adult nor childhood ASPD criteria (pure non-ASPD) revealed similar and positive responses to treatment among the three groups. The antisocial groups had more cocaine and alcohol use at the baseline evaluation, but at 7-month follow-up, they had levels of use not significantly different than the pure non-ASPD group. The findings suggest that an ASPD diagnosis or an adult antisocial lifestyle, at least as measured by DSM-III criteria, does not predict short-term treatment response.

Effect of random versus nonrandom assignment in a comparison of inpatient and day hospital rehabilitation for male alcoholics.

Alcoholic patients randomly assigned to day hospital or inpatient rehabilitation were compared with patients who self-selected these treatment settings to examine differences in substance use and psychosocial outcomes under experimental and nonexperimental designs. Patients who self-selected treatment did not have better outcomes than those who were randomly assigned, and there were no significant differences between day hospital patients and inpatients on any of the 11 outcome measures. Significant interactions between treatment setting and assignment were found with only 2 outcome measures. Therefore, the comparisons between day hospital and inpatient treatment yielded similar outcomes under both "scientific" conditions and the conditions that more closely approximate the experiences of most patients. Implications for the use of nonrandomized participants in alcoholism treatment research and limitations of the study were also discussed.

An examination of the diagnostic criteria for antisocial personality disorder in substance abusers.

In this article, we compare problem severity and adult antisocial behavior among three groups of cocaine- or alcohol-dependent patients: those with antisocial personality disorder (APD), those who met adult but not childhood APD criteria (A-APD), and those who met neither (non-APD) in order to determine the clinical utility of the A-APD category. Subjects were 269 male veterans admitted for substance abuse treatment. The Addiction Severity Index was used to determine problem severity and the NIMH Diagnostic Interview Schedule was used to obtain positive DSM-III APD criteria and APD diagnoses. More APD subjects reported arrests, illegal behavior, and chronic lying than A-APD and non-APD subjects. On several variables (recent family/social problems, trouble controlling violent behavior, and time incarcerated), A-APD subjects were intermediate in severity. Overall, the non-APD subjects had the least severe problem status. When the APD and A-APD groups were equated on number of positive adult APD criteria, the only differences that consistently remained were difficulty controlling violent behavior and commission of criminal acts, which were endorsed more frequently in the APD group. It appears that the unique contribution of the early onset criteria for the APD diagnosis is that it identifies individuals more likely to engage in criminal and violent behavior. The more general irresponsibility and disregard for the rights of others characteristic of APD is equally evident in both antisocial groups. This work indicates that the APD versus non-APD distinction may not be fine grained enough for clinical or research purposes.

Effectiveness and costs of inpatient versus day hospital cocaine rehabilitation.

We compared the effectiveness and costs of day hospital (DH) versus inpatient (INP) rehabilitation for cocaine dependence. The research subjects were 111 inner city, lower socioeconomic, primarily African-American male veterans who qualified for a diagnosis of cocaine dependence and presented no acute medical or psychiatric conditions requiring inpatient treatment. Fifty-six men were randomly assigned to 1 month of DH rehabilitation (27 hours of weekday treatment weekly), and 55 were assigned to 1-month INP rehabilitation (48 hours of scheduled treatment weekly). Treatment outcome was evaluated 7 months after admission into treatment (92% of the subjects), and a cost analysis was performed. A significantly greater proportion of INP subjects (89.1%) completed treatment than did DH subjects (53.6%). Significant improvements in substance use, psychosocial functioning, and health status were found 7 months postadmission for both groups, but there was little evidence of differential improvement between groups. Urine toxicology findings were consistent with the self-report data in showing improvement from baseline, but no group differences in cocaine use. The groups did not differ significantly in post-rehabilitation aftercare participation or in relapse to additional treatment. DH treatment costs were 40% to 60% of INP treatment costs, depending upon the measure used.

Treatment goals, continuity of care, and outcome in a day hospital substance abuse rehabilitation program.

OBJECTIVE: Relationships between day hospital treatment goals, self-help group participation, and substance use outcome were examined for 180 alcohol- or cocaine-dependent male patients in a day hospital Veterans Administration substance abuse program. METHOD: The primary goals assessed were completion of the day hospital program and participation in posttreatment self-help groups. For subjects who completed the day hospital program, progress toward three other goals was also assessed: decreased denial, endorsement of 12-Step beliefs, and participation in self-help groups during the day hospital program. The outcome measures were urine toxicology and self-reports of alcohol or cocaine use at 4- and 7-month post-intake follow-up interviews. RESULTS: Day hospital completion and participation in posttreatment self-help groups predicted better outcome. Self-help participation also predicted outcome after day hospital completion was controlled. Among subjects who completed the day hospital program, the other three goals did not predict substance use outcome. However, involvement with self-help groups during the day hospital program and decreases in denial predicted continued involvement with self-help groups. CONCLUSIONS: Patients who complete day hospital substance abuse rehabilitation and then continue to participate in self-help groups are likely to have lower rates of alcohol and cocaine use during follow-up. Furthermore, the beneficial effect of self-help group participation does not appear to be strictly the result of motivation or some other patient characteristic.

Preparations for AIDS vaccine trials. An automated version of the Risk Assessment Battery (RAB): enhancing the assessment of risk behaviors.

Our primary objective during this pilot work has been to determine if the computerized RAB can be used in place of the paper-and-pencil version with an IDU population. As stated, reliability estimates in the form of correlations of risk scores between the two versions ranged from .82 to .94, and percentages of exact agreement of the scoreable items ranged from 88% to 100%. These correlations indicate that the C-RAB is comparable to the RAB in its psychometric properties. Further, subjects' positive ratings of the computer program and perceptions that it would better protect confidentiality indicate that this population would participate in assessments involving computer interactions. While these self-reports may be biased on clients' desire to be cooperative and the novelty of the assessment approach, the high level of approval ratings suggest that a majority of participants do prefer completing assessments on the computer. Similarly, participants' demonstrated ability to use the computer and their rating of the program as easy to use suggest that the C-RAB has potential to be a reliable and efficient tool in assessing risk behaviors among IDUs enrolled in HIV vaccine trials.